The Eating Disorder Community is in Decline and I will not Pretend Otherwise

I am angry.

Not performatively angry. Not professionally offended. Not angry because I lost an argument on the internet or failed to receive applause from a community that mistakes approval for moral authority.

I am angry because my daughter is dead.

Morgan died from anorexia. On October 30, 2016, a brilliant light was extinguished. That date is not rhetoric. It is not branding. It is not “a platform,” as some room temperature IQ marketer once had the gall to call this advocacy.

It is the dividing line in my life. Before it, I was a father. After it, I became something else … a grieving father forced into a world that talks endlessly about compassion while tolerating cowardice, corruption, incompetence, ideological vanity and institutional decay.

The eating disorder community does not like anger like mine because it cannot domesticate it. It cannot convert it into a panel discussion, a diversity statement, a certification module or a social media campaign. It cannot make it polite enough to ignore.

That is why it wants people like me to be quiet.

And yet, I will not be quiet. I cannot be quiet.

After my daughter died, I tried to serve. That is what grieving parents often do when the alternative is collapse. You try to turn pain into usefulness. You tell yourself that if you can help one family, warn one clinician, reach one school, educate one employer or reach one terrified parent, then maybe the unbearable can be forced into some form of meaning.

I gave TEDx talks. I worked with physicians. I organized presentations for Apple and Raytheon. I spoke to school counselors, nurses, churches, treatment programs, television stations and radio audiences. I hosted mental health programming. I tried to bring serious voices into public spaces where eating disorders were still misunderstood, minimized or sentimentalized.

And still, it was not enough.

Eventually I learned far too late what many families have not yet learned. The eating disorder community is not merely underfunded or misunderstood. It is dysfunctional, fragmented and frightened of accountability. It too often rewards performance over substance, ideology over science, credentials over courage and consensus over truth. Worst of all, it has become increasingly comfortable using death as scenery while fighting over status.

The public is told this is a community of care. Families are told to trust the experts, the advocates, the organizations, the conferences, the language and the credentials. But behind the soft vocabulary sits a harder truth. This field remains divided on treatment, weak on accountability, vulnerable to private equity extraction, susceptible to ideological capture and far too willing to treat bereaved families as inconvenient when they ask direct questions.

The result is moral rot with professional polish.

The certification sector epitomizes this reality. Credentials now multiply like weeds. Every faction seems to have a course, a module, a preferred vocabulary and a moral test. Some programs lean clinical. Others appear more interested in political catechism than medical seriousness. One can now encounter training materials that seem more committed to ideological confession than saving lives.

Meanwhile, families still cannot get clear answers to basic questions. What treatment works best for which patient, at what stage, under what conditions and with what measurable outcome? What standards are truly evidence based? Who is tracking deaths? Who is tracking failed discharges? Who is tracking relapse after residential treatment? Who is accountable when a facility markets hope, collects enormous fees and sends a patient home no safer than when she arrived?

The field has conferences, hashtags, consultants, committees, coalitions and continuing education products. It also has frauds and charlatans.

What it does not have is a unified standard of excellence worthy of the dead.

That is the indictment.

When insurance companies dictate care, the community complains. When private equity turns residential treatment into a revenue model, the community whispers. When families are bankrupted, the community sympathizes. When clinicians disagree on basic treatment principles, the community schedules another panel. When misinformation spreads, the community looks the other way if the messenger belongs to the right social tribe. When organizations drift from mission into self-protection, the community ignores it.

But, when a grieving father says the system is failing, some of these same people suddenly pretend to discover standards of civility.

No.

Civility is not the highest virtue in a field where people are dying. Truth is. Accountability is. Competence is. Scientific seriousness is.

The eating disorder community has too often chosen theater. It has chosen language games. It has chosen familiar alliances over public correction. It has chosen to protect reputations more aggressively than families.

I have seen organizations that once claimed noble missions become captive to vanity, ideology or institutional self-interest. I have seen advocates confuse unresolved pain with public wisdom. I have seen professionals hide behind credentials while refusing to confront obvious dysfunction. I have seen activists reduce complex, lethal brain-based illnesses to social talking points. I have seen people who should know better treat mortality as an inconvenience to their preferred narrative.

This is not progress. It is decline.

And yes, I have made my fair share of mistakes. Grief does not make a man infallible. Pain does not make every judgment wise. I have spoken too sharply at times. I have misread people. I have trusted the wrong people. I have reacted when restraint would have served better.

But my mistakes are my own. They do not absolve the community of its failures.

That dodge has been used too often. Attack the messenger. Question his tone. Whisper about his anger. Pretend that if the grieving father is imperfect, then the institution is clean.

It is not.

NEDA did not need to become a stage for ideological conflict. IAEDP did not need outside pressure before obvious issues were confronted. Board certification did not need to become needlessly expensive or exclusionary. Treatment programs did not need to operate inside opaque business structures while families were told to trust the brand. The phrase “terminal anorexia” did not need to enter the field with the casual horror of professional abstraction while families wondered whether the system was preparing to give up on the very patients it had failed to save.

Again and again, the pattern is the same. The community avoids hard accountability until someone forces the issue. Then, after reform becomes unavoidable, the same community pretends the disruption was the problem.

It was not.

The problem was the misconduct. The problem was the silence. The problem was the cowardice before the lawsuits, complaints, public records and exposure.

When I acted, reform followed. Taxes, penalties and interest had to be addressed. Certification reforms moved. Chapters gained independence. Costs were reduced. Therapists were spared unnecessary expense. Research benefited. Conversations shifted. People who had been privately afraid, began to speak. I connected parents with doctors. And visited their loved ones in treatment centers.

Very few said thank you.

That is fine. I did not bury my daughter in exchange for applause.

But I will not accept lectures from people who confuse politeness with integrity. Nor will I accept moral instruction from those who watched dysfunction metastasize and called their silence professionalism.

The eating disorder community needs far less performance and far more courage. It needs fewer ideological purity tests and more scientific humility. Fewer certification pseudo empires and more measurable outcomes. Fewer self-appointed gatekeepers and more public accountability. Fewer slogans and more data. Fewer branded advocates and more grieving families at the center of the record.

It also needs to stop pretending that anger is the enemy.

Anger is not the enemy when children die, families are misled, treatment becomes a business model, public messaging drifts from science and organizations protect themselves before they protect patients.

I am angry because the stakes are life and death. I am angry because this field should be better than it is. I am angry because the public still does not understand eating disorders with the urgency they deserve. I am angry because families still enter this system terrified, uninformed, financially exposed and dependent on people who may or may not be worthy of that trust.

The enemy is complacency. The enemy is cowardice. The enemy is institutional vanity. The enemy is the professional instinct to survive scrutiny rather than deserve trust.

One more parent will soon stand where I stand. One more parent will replay the last conversation. One more parent will wonder what they missed. One more parent will be told it was not their fault and still wake each morning inside a private prison where no acquittal holds. One more parent will discover that grief is not a season. It is a climate.

So no, I will not soften this. I will not stand down. To the contrary. It is long past time for escalation. That is because the eating disorder community is in a continuing decline. And that decline is measured in more lives being taken.

A serious community welcomes scrutiny. A serious community puts mortality first. A serious community builds a public, adversarial, evidence driven forum where the brightest clinicians, researchers, families and survivors debate standards of care in full view. A serious community demands transparent outcomes from treatment providers. A serious community tracks deaths, relapses, readmissions, restraints, failed discharges, insurance denials, financial exploitation and conflicts of interest. A serious community would stop hiding behind compassion while avoiding accountability.

The eating disorder community is not serious.

That can and must change. But it will not change through another slogan, conference theme, awareness week, land use acknowledgment, moral lecture, branded certification or circular panel discussion where everyone already agrees before the microphones are turned on.

It will change when people with something to lose tell the truth. It will change when families stop mistaking credentials for character. It will change when organizations understand that their missions are not ornaments. It will change when clinicians accept that disagreement is not violence and scrutiny is not persecution. It will change when advocates stop using eating disorders as vehicles for every fashionable political obsession and return to the central fact that these illnesses kill.

My daughter died. That is where this begins. And that is where every excuse ends.

I do not write from theory. I write from the room no parent should enter. I write from the silence after the funeral. I write from the years in which grief becomes ordinary and yet still remains unbearable. I write from the knowledge that no award, no speech, no lawsuit, no reform, no public victory and no act of service can restore the life that was taken.

And so, I write. The eating disorder community can continue to resent my anger if it wants. But, I have earned my seat. I have earned it through the most horrific way imaginable. My seat in this dysfunctional community was paid with the dearest blood possible.

And until this community chooses truth over theater, science over slogans, accountability over self-protection and patients over politics, I will keep speaking and fighting.

Not because I enjoy the fight.

Because my daughter is dead.

And too many people who claim to care have become far too comfortable living with that kind of loss … so long as it belongs to someone else.

WHAT’S IN YOUR WALLET?

The last chapter in Center for Discovery’s all but played out existence is being written.

The May 11 auction of its parent company, Discovery Behavioral Health was not an ordinary sale process but instead, was a forced unwinding of a leveraged behavioral health platform. Public reporting indicates that Discovery’s lenders, Capital One and HPS Investment Partners, had already taken control after declaring the company in default on roughly $270 million in debt, removing the board and installing their own leadership structure. The auction, led by Paul Weiss lawyers, offered Discovery’s behavioral health portfolio, including eating disorder, substance use, and psychiatric assets, on an “as-is, where-is” basis to address nearly $270 million in outstanding debt.

As of now, there has been no public confirmation of the winning bidder, sale price, asset allocation or whether any third-party buyer emerged. But the structure of the process points toward the most likely result. A lender-controlled outcome, with Capital One, acting with HPS, positioned to prevail through a credit bid or credit bid equivalent rather than a cash purchase by an outside buyer.

That result would not be surprising. Under the UCC Article 9, after default a secured party may dispose of collateral in a commercially reasonable sale, including as a unit or in parcels, and a secured party may purchase the collateral at a public disposition. For a third-party bidder, Discovery’s assets present obvious friction. The portfolio was reportedly offered all or nothing and as is, where is. That means any outside bidder would need to underwrite not only the attractive assets, but also the weaker facilities, legacy liabilities, lease exposure, operational instability, payer issues and regulatory complexity embedded across the company. A secured lender by contrast, can bid its debt, take control and then attempt to sell the pieces separately.

For Center for Discovery, the immediate implication is probably not an immediate, sudden shutdown. Treatment businesses lose value quickly when census collapses, clinicians leave, licenses are disrupted or referral sources lose confidence. Discovery still publicly markets a national behavioral health platform with residential, partial hospitalization, intensive outpatient and online services. Center for Discovery itself continues to present eating disorder treatment across residential, PHP, and IOP levels of care. A lender trying to maximize recovery has an incentive to preserve going-concern value long enough to market the viable pieces.

But continuity is not the same as stability.

The more likely path is a breakup. Center for Discovery is likely to be separated from less attractive parts of the Discovery Behavioral Health portfolio and marketed as a distinct eating disorder treatment asset. That would make financial sense. Eating disorder treatment has brand value, payer relationships, geographic reach and a continuum of care that can be sold to a strategic buyer or private equity-backed behavioral health platform. Yet that same logic creates risk. Once Center for Discovery becomes an asset to be monetized rather than a clinical platform to be rebuilt, the incentives may shift toward margin protection, census preservation and sale readiness.

The greatest concern is the likely emphasis on PHP and IOP. These levels of care are increasingly attractive to investors because they carry a lower cost structure than residential treatment. They require less real estate intensity, less overnight staffing, fewer facility burdens and can be scaled more easily across markets. Industry reporting has also noted that payers favor outpatient settings such as PHP and IOP over residential programs because of lower cost and comparable outcome claims. Behavioral Health Business has likewise reported that PHP and IOP programs have expanded because they fill the gap between outpatient therapy and inpatient or residential care, while appealing to payers seeking to avoid more expensive inpatient stays.

That financial logic is precisely why the clinical risk is serious. Eating disorder care is not interchangeable across levels of care. Center for Discovery describes residential treatment as 24/7 structured support, PHP as full-day treatment often used as a step-down from residential care and IOP as a lower-intensity program for patients able to function with fewer treatment hours. If the next owner, or interim lender-controlled management group, treats PHP and IOP primarily as higher-margin substitutes for residential care, patients could be pushed into levels of care that are financially efficient but clinically insufficient.

The danger is not merely theoretical. A distressed sale process creates pressure to make the asset look cleaner, leaner and more profitable. That can mean cutting underperforming residential beds, consolidating programs, reducing staffing intensity, accelerating step-downs and emphasizing outpatient census. Each move may be defensible in isolation. Together, they can alter the clinical character of the program.

For families and clinicians, the question after the auction is therefore not only who owns Center for Discovery. The harder question is what the new owner intends to preserve. A responsible transition would protect clinical staffing, maintain appropriate level-of-care determinations, honor existing treatment plans, preserve continuity for patients already admitted and avoid using PHP or IOP as a financial substitute for residential treatment when residential care is clinically indicated.

The likely auction result may give Capital One and HPS a path to recover part of their debt. It does not answer the more important question for patients … whether Center for Discovery will remain a treatment system or become a collection of monetizable outpatient assets.

Perhaps Capital One’s catch phrase, “What’s in your wallet?” needs to be adjusted to “What’s in your wallet? Less, if Capital One holds the note.”

The latest hobgoblin to perplex the eating disorder community is the use of GLP-1 medications. Competing presentations and articles are being published. Accusations of bias are already bandied about. This raises the inevitable question … was the talk or article biased or was it simply incomplete?

That distinction matters more than it may first appear. To call a presentation “biased” is to suggest a fundamental defect. It implies bad faith, intellectual contamination, or a failure so basic that the speaker’s credibility is diminished. The word often operates as an accusation, and once it enters the lexicon, the conversation itself changes. People retreat into defensive positions. Groups harden. The possibility of productive engagement narrows.

But to refer to a presentation as “incomplete” is different. “Incomplete” does not excuse weakness. It identifies it with precision. It says the subject required more voices, more context, more rigor, more disciplines, more lived experience, more challenge. It leaves room for the possibility that the presenter was building something rather than distorting something. It invites participation rather than condemnation. It allows the field to ask; What is missing? Who was not included? What assumptions were left untested? What would make this stronger?

That distinction, bias versus incompleteness, goes to the heart of a systemic problem within the eating disorder community.

Too often the field does not possess the structures necessary to metabolize disagreement. It does not consistently bring opposing views into disciplined, accountable deliberation. Instead, it allows major questions to emerge through fragmented presentations, isolated publications, advocacy statements, rebuttals, counter-rebuttals, and public controversy. The result is not consensus. It is not clarity. It is not reform. It is serial reaction and in some cases, overreaction.

Terminal anorexia, weight stigma, obesity, residential treatment, involuntary care, medical stabilization, private equity, insurance denial and the role of families. The debate over GLP-1 medications is only the latest example.

Given the stakes, the introduction of GLP-1s into the eating disorder conversation should have triggered a process proportionate to the seriousness. These medications raise profound clinical, ethical, metabolic, psychological, social and even spiritual questions. They implicate body weight, appetite, medical risk, obesity treatment, relapse vulnerability, access to care, stigma, autonomy, coercion, and the meaning of recovery itself.

A mature field would have responded by convening a serious, multidisciplinary process. Not a panel designed to affirm one position. Not a paper written from one perspective. Not a series of advocacy reactions after the fact. A real process.

That process should have included eating disorder clinicians, obesity medicine specialists, psychiatrists, endocrinologists, researchers, ethicists, patients, families, disability-rights advocates, theologians, legal scholars, and people with lived experience across different diagnostic and body size realities. It should have directly examined assumptions. It should have asked what is known, what is unknown, what is being inferred, and what risks are being underestimated. It should have distinguished clinical concern from ideological reflex. It should have clarified where caution is warranted and where fear may be substituting for evidence.

Instead, the field did what it too often does. It processed the issue through fragmentation.

One group speaks. Another group objects. A paper appears. A blog responds. A statement circulates. A conference panel frames the issue one way. A counter-panel frames it another. Advocates describe harm. Clinicians defend nuance. Researchers ask for data. Patients feel unseen. Families remain confused. Positions harden before the field has created a shared table at which those positions can be tested.

And nothing durable is built. This is not structured deliberation. It is intellectual trench warfare. This trench warfare has become the eating disorder field’s primary method of adjudication.

What does not emerge is institutional architecture capable of absorbing disagreement and converting it into accountable consensus. That absence is not a minor procedural flaw. It is one of the field’s central weaknesses.

A field dealing with a life-threatening illness cannot rely on sequential publication as its primary conflict resolution mechanism. Publication has value. Scholarship matters. Commentary matters. Advocacy matters. But none of those alone can substitute for a legitimate consensus building structure. Papers do not cross-examine assumptions in real time. Advocacy statements do not reconcile competing clinical realities. Conference talks do not create binding standards. Public rebuttals do not necessarily produce shared definitions.

They often produce only more hardened factions.

A system that can only process new and consequential concepts through this fragmented process is not demonstrating intellectual vitality. It is demonstrating procedural weakness. It is showing that it lacks the mechanisms needed to test its most important ideas before they migrate into practice, policy, treatment settings, insurance decisions and public discourse.

That matters because ideas in this field are not abstract. They become clinical posture. They influence whether patients are hospitalized or discharged. They shape how risk is understood. They affect whether families are included or marginalized. They determine whether weight loss is celebrated, feared, treated, or ignored. They define whether a patient is viewed as resistant, autonomous, hopeless, harmed, empowered, or in need of urgent intervention.

Language becomes practice. Practice becomes outcome. Outcome becomes life or death.

The eating disorder community cannot continue treating disagreement as contamination. It cannot keep mistaking opposition for hostility. It cannot continue allowing each faction to speak from its own platform while pretending that the existence of multiple platforms equals meaningful discourse. It does not.

Real discourse requires structure. It requires shared rules. It requires the willingness to sit beside a person who sees the issue differently and remain engaged long enough to understand why. It requires humility from researchers, clinicians, advocates, families, and patients alike. It requires the recognition that no single constituency owns the truth. Separate truths may coexist. A serious field must be able to hold both simultaneously.

The current model does not do that well. The current model rewards position taking more than integration. It rewards rapid response more than disciplined synthesis. It rewards moral clarity, even when the underlying issue is clinically and ethically complex. It allows organizations to issue statements, scholars to publish frameworks, advocates to mobilize outrage, and clinicians to continue practicing amid uncertainty … without requiring the field as a whole to reconcile competing truths.

That is not consensus. That is convenience.

The path forward is not silence. It is not politeness for its own sake. It is not pretending that all views are equally supported by evidence. Some arguments are stronger than others. Some claims are dangerous. Some assumptions deserve to be challenged directly. But the challenge must be structured.

The field needs a new model for consequential disagreement. When the next major issue arises the response should not be another isolated paper followed by predictable backlash. It should be a convened process with opposing experts, clear questions, transparent assumptions, defined evidentiary standards, patient and family participation, ethical review, and a published consensus document that identifies agreement, disagreement, uncertainty, and practical guidance.

Not every issue will end in unanimity. It should not. Forced consensus can be as dangerous as fragmentation. But a credible process can at least clarify the boundaries of disagreement. It can say … here is what we know; here is what we do not know; here is where clinical caution is justified; here is where ideology may be exceeding evidence; here is where patient safety requires action; here is where further research is essential; here is how families and clinicians should proceed in the meantime.

That would be progress.

The eating disorder field does not suffer from a lack of passion. It suffers from a lack of integrative structure. It has brilliant clinicians, committed researchers, courageous patients, grieving families, thoughtful advocates, and people of genuine moral seriousness. But intelligence distributed across factions does not automatically become wisdom. Wisdom requires architecture.

The eating disorder community must move beyond the zero-sum game. It must stop treating incompleteness as bias and disagreement as betrayal. It must build the institutional capacity to hold complexity without collapsing into camps. It must recognize that the goal is not for one tribe to defeat another. The goal is to produce better care, better standards, better evidence, better ethics, and better outcomes.

Lives depend on whether the field can learn to do that.

WHAT AM I BID FOR …

For people in the eating disorder community, this is not an abstract finance story. This is Center for Discovery, one of the most recognizable names in eating disorder treatment, a brand that for years presented itself as a leader in residential and outpatient care for adolescents and adults, and a major component of the larger Discovery Behavioral Health platform. That platform reportedly expanded across 16 states and more than 150 treatment centers at its peak.

On May 11, 2026, in the offices of a New York City law firm, shattered pieces of the Discovery Behavioral erstwhile empire, including Center for Discovery, are set to be sold in a private auction, “as-is, where-is,” to address nearly $270 million in debt.

The “as is, where is” phrase matters.

Families were sold something very different; expertise, safety, continuity, and clinical necessity. What is now being sold is the underlying reality. Center for Discovery was not just a treatment program. It was primarily collateral inside a leveraged financial structure.

Discovery’s history makes the point. Investors behind Webster Equity Partners, a private equity firm, bought the company in 2011. It later recapitalized and merged assets into what became Discovery Behavioral Health. It then went on an acquisition spree across eating disorder, psychiatric, and substance-use treatment. In 2021, Discovery reportedly refinanced with a $163 million term loan, a $30 million revolver, and an $86 million delayed draw commitment from HPS and Capital One. This was not organic growth because outcomes were so compelling the field could not ignore them. This was private equity doing what private equity does … consolidating a fragmented market, leveraging the platform, and expanding first while leaving proof and sustainability for later.

Then later arrived.

Discovery’s former CEO reportedly acknowledged in 2024 that its six-bed residential model had become unsustainably expensive because labor and operating costs were rising while payer reimbursement was not keeping up. That is not a side note. It is the business model speaking plainly. One of the very models the eating disorder world has been taught to regard as intimate, specialized, and clinically superior was also financially fragile. It worked until the math stopped cooperating.

After covenant breaches, missed reporting obligations, and an accounting reclassification that lenders viewed as a maneuver to avoid default, HPS and Capital One seized control in December 2025. It abruptly replaced leadership and moved the business toward sale. So yes, after years of telling families that these institutions existed to save lives, the market has finally clarified the arrangement.

What am I bid for Center for Discovery?

We are justified in asking who are the likely bidders. No one outside the process should pretend certainty, but the most obvious possibilities are: the lenders themselves through a credit bid; distressed healthcare investors; private equity buyers looking for selected assets at a discount, and; strategic operators who want individual programs, licenses, or regional footprints rather than the whole platform.

In other words, the bidders are unlikely to be grieving families or clinicians trying to preserve a mission. They are likely to be people asking a cold-hearted question … which pieces are still worth something, and on what terms?

So what happens to Center for Discovery after that? Again, no one should pretend certainty. But the usual possibilities are not mysterious. CFD may continue under new ownership. CFD may be rebranded. It may be consolidated with other treatment centers. It may be stripped of its most valued assets, if any, for sale to the highest bidder. It may close if it does not fit the buyer’s economics.

That is what happens when a treatment network is revealed to be a portfolio before it is a public trust.

But there is one undeniable truth. CFD has failed and has betrayed the families it pledged to help.

So, at this point families may be asking if they should leave their loved ones in Center for Discovery facilities. That answer is not simple and anyone pretending otherwise is being reckless. Families should not panic and abruptly remove a loved one without a continuity plan especially if that person is medically fragile. Sudden disruption in eating disorder treatment can be dangerous. But families also should not passively assume that a recognizable, failed brand name still guarantees stability. At a minimum, they should be demanding direct answers to the following questions from facility leadership …

Is this specific program being sold, transferred, or retained?

Will clinical staff remain in place?

Is there any risk of closure, consolidation, or transfer?

What is the contingency plan for continuity of care?

Who will notify families if ownership changes?

Are there any changes in medical coverage, supervision, or discharge planning?

If a facility cannot answer those questions clearly, families should understand that as a warning sign, not an inconvenience … and act accordingly. Nothing is more important than the health and life of your loved one.

And no one in the eating disorder system should pretend that this is only about Center for Discovery.

Center for Discovery is simply the first case dramatic enough to make the architecture visible. If the treatment system depends on high-cost residential care, rising labor costs, payer resistance, lease drag, and heavy debt, there is no serious reason to think Center for Discovery will be the last emblem of the private equity era to fall in public. It may only be the first one wheeled into the auction room while the rest of the industry stares determinedly at the floor.

That is what makes this moment so important for the eating disorder community. Center for Discovery was not outside the system. It was one of the institutions that helped define it. One of the brands that normalized residential expansion. One of the names families were taught to trust.

Trust. The eating disorder system defined it. The eating disorder system betrayed it.

If Center for Discovery can be repossessed, stripped, and marketed for sale, then perhaps the question is no longer whether the system is unstable.

Perhaps the question is how long everyone intends to keep pretending this is an exception. Because there will be others. Center for Discovery is merely the first domino. Which brings us back to the first question …

What am I bid for … Center for Discovery?

Advocacy Masquerading as Evidence: A Systematic Critique of GLP-1 Misinformation

On April 6, 2026, the journal, Fat Studies – The Interdisciplinary Journal of Body Weight and Society published the article, “GLP-1 medications for weight-loss: a triumph of marketing over patient care.” Written by Regan Chastain, Angela Meadows and Louise Adams, it is best understood not as a neutral clinical review but as an activist driven critique shaped by explicit ideological commitments.

This is not a baseless observation. It is disclosed within the paper itself and reinforced by the authors’ professional backgrounds. None of the three authors is a medical doctor, endocrinologist, cardiologist, or specialist in obesity medicine. Instead, the contributor statements identify them as a patient advocate and health writer (Chastain), a psychologist specializing in weight stigma (Meadows), and a clinical psychologist and weight inclusive health advocate (Adams). These are legitimate perspectives. But they are not equivalent to clinical trialists or physicians managing cardiometabolic disease.

More importantly the paper explicitly states that the authors “reject weight loss as a valid goal for individual or population level health promotion.” That declaration establishes a prior normative commitment that materially shapes the analysis. This is also known as “confirmation bias.”

When a paper begins by rejecting the primary therapeutic endpoint of the drugs under review, its conclusions are necessarily constrained by that premise. The result is not an open evaluation of evidence, but a framework in which any observed weight loss is either discounted, reframed as harm, or treated as irrelevant to health.

This foundational stance informs one of the paper’s most conspicuous factual distortions, the characterization of weight loss as a “side effect” that is intentionally “magnified” through high dosing. In the context of FDA approved obesity treatments such as semaglutide (Wegovy) and tirzepatide (Zepbound), weight loss is not an unintended side effect; it is the primary therapeutic objective.

Clinical trials are designed with weight reduction and related health outcomes as endpoints, and dosing is titrated based on efficacy and tolerability, not arbitrarily maximized to induce harm. Reframing the intended therapeutic effect as a “side effect” is not merely imprecise language. It is a rhetorical maneuver that allows the authors to imply that the treatment paradigm is inherently perverse. This constitutes a category error that undermines the paper’s credibility at the level of basic pharmacological description.

The paper’s treatment of clinical evidence further reflects a pattern of selective skepticism. The authors repeatedly emphasize industry funding, conflicts of interest, and pharmaceutical marketing as reasons to distrust the underlying evidence base. While these concerns are legitimate and important, they are deployed in a way that amounts to a genetic fallacy. The validity of clinical trial results is implicitly questioned based on their origin rather than their methodology, reproducibility, or regulatory scrutiny. At no point do the authors engage meaningfully with the fact that these trials undergo independent peer review, regulatory evaluation, and in many cases, replication across multiple studies and populations. Instead, financial entanglements are used as a proxy for unreliability.

This asymmetry becomes more pronounced when contrasted with the authors’ own evidentiary standards. While clinical trials are scrutinized for bias, the paper itself relies heavily on non-systematic sources, including journalism, activist materials, and even “personal communications.” The result is a double standard in which high evidentiary thresholds are applied to opposing evidence and substantially lower thresholds to supporting claims.

A similar pattern appears in the paper’s interpretation of major clinical trials, particularly the SELECT cardiovascular outcomes study. The authors criticize the widely reported 20% risk reduction as misleading because it represents relative rather than absolute risk, noting that the absolute difference was approximately 1.5%. While it is true that relative risk can be rhetorically amplified, presenting absolute risk in isolation is equally capable of minimizing clinically meaningful effects. Both measures are standard in medical reporting and are intended to be interpreted together.

By framing relative risk as exaggeration and absolute risk as trivialization, the paper engages in selective statistical framing rather than balanced analysis. This issue is compounded by the authors’ reliance on subgroup analyses to argue that benefits are not broadly applicable. They note that certain subgroups did not show statistically significant results but fail to acknowledge that such analyses are often underpowered and not designed to establish definitive absence of effect. Treating non-significant subgroup findings as evidence that benefits do not exist is a well-known statistical error.

The paper’s handling of trial attrition and long-term outcomes further illustrates a tendency toward speculative inference. For example, the authors suggest that high attrition rates in the SELECT trial imply that results overestimate long-term efficacy, and they hypothesize that participants with poorer outcomes were more likely to withdraw. However, this claim is not substantiated with evidence demonstrating the direction or magnitude of attrition bias. Modern randomized controlled trials routinely employ intention-to-treat analyses and other statistical methods to mitigate such biases.

Without demonstrating that attrition systematically favored positive outcomes, the authors’ conclusion remains conjectural. Similar questionable reasoning appears in their discussion of weight regain, where findings from withdrawal studies and historical dieting literature are extrapolated to predict long-term failure of GLP-1 therapies. While weight regain after discontinuation is well documented, projecting this pattern onto long-term continuous pharmacotherapy without sufficient longitudinal data constitutes an overextension of the available evidence.

The paper’s treatment of adverse event data is particularly problematic from an epidemiological standpoint. The authors cite large numbers of adverse events and deaths reported in the FDA Adverse Event Reporting System (FAERS) and suggest that these figures indicate significant risk. However, FAERS is a passive surveillance system that collects voluntary reports and does not establish causality. It also lacks a denominator, meaning the total number of users is not accounted for.

As a result, raw counts of adverse events cannot be used to infer incidence rates or comparative risk. Presenting these figures without appropriate context creates a misleading impression of danger. The claim that GLP-1 drugs “exceed the death toll” of prior withdrawn weight-loss medications is especially flawed, as it fails to normalize for vastly different exposure levels and durations of use. This is a classic example of an apples-to-oranges comparison that inflates perceived risk.

Methodologically, the paper’s analysis of pharmaceutical marketing practices is also weak. The authors acknowledge that their evidence was drawn from a “convenience sample of Google search results” and selected examples from journalism and public sources. This approach is neither systematic nor reproducible and is highly susceptible to selection bias and confirmation bias. Nevertheless, the authors generalize from these examples to characterize a global, coordinated campaign shaping the narrative around obesity and GLP-1 drugs. While there is ample evidence that pharmaceutical companies engage in aggressive marketing, the paper’s methodology does not support the breadth of its conclusions. The critique may be directionally valid, but it is not methodologically rigorous.

The paper repeatedly conflates sociocultural critique with clinical evaluation. Extended sections discuss weight stigma, body image, and the cultural meaning of fatness, often framing the use of GLP-1 drugs as part of a broader “anti-fat” or “eliminationist” narrative. These are important sociological considerations, but they do not directly address the clinical question of whether the drugs improve health outcomes for patients with obesity related conditions. The implicit argument, that because weight stigma exists, medical interventions targeting weight are suspect, does not logically follow. This conflation allows normative concerns about social justice to substitute for empirical evaluation of efficacy and safety.

In sum, the article raises several legitimate issues including the influence of pharmaceutical marketing, the prevalence of conflicts of interest, the challenges of long-term adherence, and the importance of informed consent. However, these valid concerns are embedded within a framework characterized by pre-committed ideological assumptions, selective interpretation of evidence, misuse of statistical and epidemiological data, and methodological weaknesses.

The authors’ explicit rejection of weight loss as a legitimate health goal, combined with their non-clinical backgrounds and advocacy oriented positioning, reinforces the conclusion that this is not a balanced medical review. Rather, it is a perspective piece that critiques GLP-1 therapies from within a specific ideological paradigm, and its conclusions should be evaluated with that context clearly in view.

Which brings us to the final point. The current discourse surrounding GLP-1 medications particularly within the eating disorder community has become increasingly polarized, with positions often shaped more by ideological alignment than by balanced clinical evaluation. Competing camps advance claims of authority over a complex and evolving area of medicine, responding to one another not with constructive engagement, but with entrenched rebuttal. This dynamic does little to advance patient care. Instead, it reinforces fragmentation, inhibits meaningful dialogue, and ultimately leaves patients and families navigating uncertainty without the benefit of a coherent, multidisciplinary consensus.

This pattern is neither new nor unique, but its consequences are particularly acute in a field as clinically sensitive as eating disorders, where nuance, individualized assessment, and careful risk-benefit analysis are essential. When discourse devolves into parallel monologues rather than genuine exchange, [see, Terminal Anorexia] opportunities for progress are lost. The absence of collaboration among stakeholders, clinicians, researchers, and advocates creates an environment in which important questions remain insufficiently examined and practical guidance remains underdeveloped.

By contrast, there are models for a more constructive approach. Recent clinical discussions led by experienced physicians underscore the value of measured, evidence-based engagement with this issue. For example, presentations by clinicians such as Dr. Anne O’Melia reflect a balanced perspective grounded in decades of experience treating eating disorders. Such perspectives acknowledge that GLP-1 medications when appropriately prescribed and carefully monitored, may offer benefits in certain contexts, while also recognizing that they may pose significant risks in others. Similarly, clinicians like Dr. Wendy Oliver-Pyatt have emphasized the importance of rigorous risk-benefit analysis and fully informed consent particularly in vulnerable populations. These are not absolutist positions; they are clinically grounded, context-sensitive frameworks.

One can readily envision this type of productive discourse in which such perspectives are brought into direct, professional engagement. Where clinicians with differing views examine the same body of evidence, interrogate assumptions and refine understanding through structured dialogue. A forum characterized by medical rigor, intellectual honesty, and mutual respect would yield far greater insight than the current pattern of isolated advocacy and reactive critique.

As with many areas of contested medical practice, progress will not emerge from unilateral assertions of certainty but from sustained, interdisciplinary collaboration. The complexity of GLP-1 therapies, spanning metabolic, psychological, and behavioral domains demands precisely this kind of engagement. A more integrated approach would better serve not only the advancement of clinical knowledge, but also the patients and families who depend on it.

The best way to embrace the future, to increase our understanding of eating disorders, to reach enlightened consensus … is through collaboration.

Sick Enough (Second Edition) by Dr. Jennifer L. Gaudiani

Dr. Jennifer Gaudiani’s first book, Sick Enough became one of the most influential medical texts on eating disorders for a mixed audience of clinicians, patients and families. Her recent Second Edition considerably expands its reach. It is broader in diagnostic scope, more explicit in its rejection of weight stigma, and more attentive to populations historically marginalized within eating disorder discourse, patients in larger bodies, those with ARFID or atypical anorexia, athletes, neurodivergent individuals and others.

The second edition is a substantial, clinically ambitious and humane book. This is an updated guide with a wealth of information for patients, families, and clinicians. It has an expanded coverage of weight-inclusive care, “unmeasurable” medical problems such as Positional Orthostatic Tachycardia Syndrome (POTS) and Mast Cell Activation Syndrome (MCAS) and includes specific populations such as athletes, people in perimenopause, and those with PTSD or ADHD.

Its table of contents also shows a broader scope than a narrow anorexia only manual. The Second Edition covers purging, BED, ARFID, atypical anorexia, recovery and several special populations.

It is one of the strongest medically oriented eating disorder books for a mixed audience. Especially if the reader wants a text that combines clinical seriousness with anti-stigma framing. Its greatest strength is that it repeatedly emphasizes that eating disorders are medically dangerous across body sizes and presentations. However, one of its limitations is that it can be too expansive, too clinician-shaped, and at times too structurally diffuse for readers who want either a purely patient facing guide or a tightly organized medical handbook.

What the book does very well

The Second Edition directly attacks the “not sick enough” myth. This is the book’s central moral and medical achievement. Dr. Gaudiani makes the case that eating disorders are not validated by emaciation alone and that serious risk can exist in larger bodies, in atypical anorexia, in purging disorders, and in undernutrition that is not socially legible. The Second Edition’s explicit emphasis on weight stigma and weight inclusive philosophy is one of its defining strengths.

That matters because many books on eating disorders still smuggle in a hierarchy of seriousness. Sick Enough pushes against that hierarchy. It is corrective in the best sense, not merely compassionate, but clinically corrective.

The book also bridges medicine and lived experience better than most clinician authored books. The book emphasizes case presentations, stories, metaphors, practical strategies, and approachable science. That combination seems to be the key to the book’s reputation. An independent professional reviewer noted that Dr. Gaudiani combines expertise with a compassionate tone and keeps the book accessible without drowning newer readers in jargon.

This is important because eating disorder medicine can quickly become alienating. A text can be medically accurate yet useless to frightened patients or exhausted families. Dr. Gaudiani appears to avoid that trap by translating physiology into understandable language without trivializing it.

The table of contents shows a book that does not stop at restrictive anorexia. It includes chapters on purging, BED, ARFID, atypical anorexia, recovery, neurodiversity, diabetes, athletes/REDs, males, gender and sexual minorities, sexual and reproductive health, substance use, older age, and gastrointestinal or autonomic complications.

That breadth makes it unusually useful in real world practice where some patients rarely present as textbook stereotypes. The Second Edition seems designed to reflect the heterogeneity of eating disorders rather than forcing everyone into one familiar clinical script.

The Second Edition explicitly includes a section on “The Unmeasurables,” including MCAS and POTS. Whether every reader will agree with the framing, this signals one of the book’s core virtues. It approaches in a professional manner, the messy borderlands of eating disorder medicine where symptoms may be debilitating even when medicine has not produced neat explanatory boxes.

That gives the book emotional and clinical credibility. Patients with complicated, long-standing illness often feel erased by handbooks that only recognize what fits clean laboratory or diagnostic boundaries.

A number of medical treatises are technically solid but ethically thin. Sick Enough seems to understand that care is not just about identifying bradycardia, electrolyte derangement, endocrine suppression, or GI dysfunction. It is also about how bias delays treatment. The weight stigma material is not simply ornamental. That makes the book more than a manual. It is also an intervention into how clinicians think.

Room for Improvement or Greater Clarity

As with all books, papers, studies and treatises there are areas for greater explanation and clarity.

The organization of the Second Edition may frustrate readers who want a classic systems-based handbook. One independent review from a dietitian praised the book but made a sharp structural criticism, that it did not organize material primarily by body system, so a reader trying to track for example, cardiovascular or GI consequences across diagnoses may need to jump between chapters.

That is a meaningful weakness. For a clinician in a hurry or a student trying to build a clean mental map, a systems based structure can be more efficient. Dr. Gaudiani’s presentation-by-presentation approach may feel more human and clinically realistic, but it is not always the fastest for cross-referencing.

The Second Edition also may be too medical for some patients and too general for some specialists. This is a classic hybrid text problem. By trying to serve patients, loved ones, and clinicians at once, the book likely lands a little imperfectly for each subgroup. For patients early in illness or recovery, the sheer amount of medical detail may feel overwhelming. For subspecialists already steeped in eating disorder medicine, some sections may read as broad synthesis rather than cutting edge dispute. That does not make the book weak. It makes it broad. But broad books inevitably trade some depth for reach.

One of Dr. Gaudiani’s strengths is having a strong clinical voice. The downside of that voice, in any physician authored guide, is that it can sometimes produce a subtle asymmetry. The reader is being expertly guided, but nonetheless guided. For some readers, especially those wary of medical paternalism, this can feel comforting; for others, it can feel managed.

There are also some topic choices which may invite debate. [Debate has never been a weak spot for Dr. Gaudiani.] The inclusion of conditions such as MCAS and POTS under “unmeasurables” will resonate deeply with some readers and prompt skepticism from others, especially readers sensitive to how contested syndromes are discussed in medicine.

That is not necessarily a flaw. But it does mean the book is not purely conservative in scope. It steps into areas where interpretation, causality, and framing are complicated. Some will see that as brave and patient honoring. Others will worry it risks overextension.

Sick Enough does underscore the lethality of eating disorders and makes clear that anorexia nervosa carries the highest mortality rate of any psychiatric illness, citing markedly elevated death rates relative to healthy peers and a significant contribution from suicide. However, the book does not organize this point as a sustained comparative analysis across diagnoses. Instead, it embeds the explanation within its broader medical framework. The cumulative effects of prolonged undernutrition, multi-system physiological deterioration, and heightened suicide risk. In this way, Dr. Gaudiani establishes the mortality hierarchy clearly, but explains it implicitly through the biology of starvation and clinical risk rather than through a dedicated, diagnosis-by-diagnosis examination of mortality mechanisms.

The best features and biggest improvements in the Second Edition appear to be: a stronger emphasis on weight stigma and weight-inclusive care; broader recognition of ARFID, atypical anorexia, BED, and diverse patient groups; added treatment of neurodiversity and psychiatric complexity;  inclusion of POTS, MCAS, and complex digestive issues, and; more explicit attention to athletes, males, gender/sexual minorities, sexual and reproductive health, and older adults.

That is exactly the sort of expansion a Second Edition should make. Not just “more studies,” but a wider and more current model of who gets sick and how illness presents. The Second Edition may be structurally imperfect as a reference manual, occasionally vulnerable to being too broad for specialists and too dense for lay readers, and open to debate in some of its more complex “unmeasurable” territory.

However, it is authoritative, compassionate, modern in its anti-stigma stance, broad in diagnostic scope, and far better than most medical books at explaining why a person can be very ill without “looking sick.” It seems especially strong on translating eating disorder medicine into language usable by non-specialists.

Although not flawless, [what book is?]  it is the kind of book that can genuinely change how people understand eating disorders: medically, morally, and diagnostically.

That is rare.

Which makes the Second Edition a must read for medical and mental health professionals and not just those in the eating disorder community.

What Chiles and the Meta Cases Mean

Therapists have expressed concern about the recent Supreme Court decision in Chiles v. Salazar and what it means for their practice. They see this decision as a ruling about conversion therapy. But that framing is far too narrow. What the Court actually determined is far more consequential for your practice. The opinion partially redefined psychotherapy as protected speech under the First Amendment. In doing so, it changed where accountability for therapists will now live.

Before this decision, states could draw bright lines; certain therapeutic practices were simply prohibited, and licensing boards enforced those prohibitions directly. That framework is now constitutionally unstable if it depends on viewpoint.

After Chiles, the rule is now closer to … the state cannot ban what you say in therapy based on ideology.  But it can still hold you accountable for how your speech functions as treatment. That is not a small adjustment … it is a structural shift.

The Court’s reasoning elevates therapy into one of the most protected categories in constitutional law. Because therapy is not casual speech. It occurs inside a fiduciary-like relationship, a context of trust and dependence and a setting where influence is not incidental, it is the point. So while your speech is protected from government censorship, it is not insulated from professional responsibility or liability. That distinction will define the next decade of litigation.

Courts will be moving away from asking, “Is this category of therapy allowed?”And toward asking, “Did this therapist, in this specific case, use their professional authority in a way that caused harm?” That means no more categorical bans as the primary tool. Instead, it will mean more malpractice claims, board complaints, and fact-specific investigations. Critically the question is no longer what you believe … it is how you operationalize those beliefs in treatment.

Let’s also review what the opinion did NOT do.  The Court did not resolve whether all therapeutic modalities are speech, e.g., behavioral therapy vs. talk therapy.  The Court did not explicitly declare that psychotherapy is fully protected speech in all respects. Instead, it held that when psychotherapy consists of conversational exchange, the state cannot regulate it based on viewpoint.

The Court rejected the idea that therapy is merely “conduct with incidental speech” and instead treated it as speech-based activity that falls within core First Amendment protection. This is a major shift because it undermines prior cases that treated therapy as regulable professional conduct. For many clinicians, especially those grounded in progressive, client centered practice, the instinctive reaction may be concern about losing regulatory protections against harmful approaches. That concern is valid. But it is only half the story.

The other half is this, as formal regulation weakens, individualized legal and professional scrutiny intensifies.

The Practical Reality for Therapists

Think of it this way. Before the decision, the state could say, “You are not allowed to use this type of therapy.”  Now, the state generally cannot say, “You are not allowed to express this particular idea or perspective in therapy.” For example, the state cannot interrogate you on the following topics, “You cannot question gender transition,” or “You cannot support gender transition” or “You cannot explore certain identity outcomes.” Why?

Because that would be viewpoint based. It is picking which ideas are allowed and which are not. The Court says that violates the First Amendment. But the state can still say, “You are responsible for how your therapy affects your client.”

What You Are Now More Free to Do

After the Chiles decision, you have more freedom to explore controversial ideas, discuss difficult or politically sensitive topics, work outside strict ideological boundaries or use approaches that are not explicitly endorsed by the state.  In short, you have more freedom in what you can say and explore in session. Indigenous person’s land use acknowledgement? Knock yourself out. Blaming all of society’s ills on the evil white man? Go ahead.

But that freedom comes with a very important limitation. You are still responsible for how your work impacts the client. So, the real question is no longer, “Is this allowed?” It becomes, “Can I justify this as responsible, appropriate care for this client?”

The takeaway is the biggest risks are not about having views. They are about how those views show up in therapy. You may be at risk if you present your beliefs as the “correct” answer instead of helping the client explore their own thinking. Or, if you steer or pressure the client especially on major identity or life decisions. Or, if you move outside generally accepted standards of practice without explaining it and without making sure the client understands what you’re doing. Or, if the client is vulnerable and things get worse and your approach played a role in that.

This reality aligns with broader trends impacting your mental health practice. Across recent cases involving Meta and Google, courts have been reluctant to restrict speech outright, but increasingly willing to scrutinize actors who shape outcomes for vulnerable audiences. That framework translates almost perfectly to therapy. You are not a passive speaker. You are not a neutral platform. You are a professional with structured influence over a vulnerable individual.

This places therapists into what is effectively a “high-responsibility speech” category. Yes, speech is protected. But responsibility increases with power, trust, and foreseeability of harm. Paradoxically, greater speech protection can mean greater exposure. This is because you no longer operate under clear categorical rules and instead operate under case-by-case scrutiny.  Risk concentrates in situations where personal ideology is presented as clinical necessity, client autonomy is subtly overridden, approaches depart from recognized standards without justification and vulnerable clients (especially minors) experience deterioration.

In those cases, the issue will not be, “Was this viewpoint allowed?” It will be, “Was this professional conduct defensible?”

The therapy room is now more protected from government interference but more exposed to individualized scrutiny … by courts, boards, and clients. You have greater freedom to speak. But you are also more accountable for how you use your authority, how you justify your methods and how your interventions affect vulnerable people.

The most important change is not what therapists are allowed to say. It is what they must now be prepared to defend. And that defense will not be ideological. It will be clinical, evidentiary, and grounded in whether what happened in the room can be justified as responsible care.

The March 25, 2026 jury verdict in Los Angeles against Meta and Google, paired with the $375 million New Mexico verdict against the same companies the day before, mark a structural shift in how courts conceptualize harm arising from social media platforms. These cases do not merely expand liability. They reframe the legal ontology of digital platforms from neutral intermediaries into potentially defective consumer products.

In this article, we will explore what this means for the way in which we look upon eating disorders … and what therapists and clinicians should know.

For eating disorders, conditions already deeply entangled with algorithmic amplification, body image distortion, and compulsive engagement, the shift in liability for digital platforms is particularly consequential. The emerging litigation theory may provide for the first time a coherent legal pathway to attribute causation and duty in eating disorder related harm.

The recent Meta/Google verdicts succeeded because plaintiffs changed the theory of liability. The old framing was, “You allowed harmful content to exist.” Federal statutes provided immunity for this reasoning. Case dismissed.

The new framing is now, “You designed a system that predictably causes harm.” This is the doctrinal pivot. The plaintiffs were able to bring forth evidence that the platforms knew about harm (e.g., to teens, body image, ED risk) but continued optimizing engagement anyway. This evidence supports claims of negligence, recklessness and malice. This also strengthens the argument that the wrongdoing lies in corporate decision making not user content.

Why This Matters Specifically for Eating Disorders

Eating disorder harm fits the “Design, Not Content” model argued in courtrooms. Eating disorders are not typically triggered by a single post. But by repeated exposure, escalating comparison and behavioral reinforcement. These are clearly algorithmic phenomena.

Unlike traditional media, social media platforms can identify users engaging with dieting and body comparison content. This increases the likelihood of exposure. This frames a plaintiff’s argument that harm is not incidental. It is systematically intensified. There is also substantial evidence that social comparison leads to body dissatisfaction and repeated exposure leads to disordered eating behaviors

This makes it easier to argue that harm was predictable, foreseeable and safer alternatives were available but disregarded.

The recent verdicts are also significant not because they establish a medical causation of eating disorders, but because they elevate platform design and algorithmic exposure into the realm of foreseeable mental health risk.

In effect, the verdicts reinforce three propositions that are directly relevant to clinical practice:

  1. Digital environments can function as risk-amplifying exposures, particularly for adolescents;
  2. Algorithmic curation is not neutral, but can intensify engagement with appearance focused or psychologically harmful content; and
  3. Harm need not arise solely from user intent but may be driven by product design features.

From a standard-of-care perspective, these propositions are likely to influence what constitutes “reasonable” clinical conduct.

Even in the absence of formalized guidelines, foreseeability plays a central role in negligence analysis. As juries begin to recognize social media design as a source of mental health harm, clinicians may be expected to:

  • Screen for social media use with greater specificity (not merely duration, but type of content and engagement patterns);
  • Identify platform-related triggers (e.g., comparison behaviors, exposure to body-ideal content, reinforcement loops);
  • Incorporate digital environment management into treatment planning; and
  • Provide anticipatory guidance to patients and families regarding online risk factors.

Failure to do so over time may be framed as a deviation from evolving professional norms even in the absence of codified standards.

Evolution of Standard of Care Through Litigation Rather Than Consensus

In fields lacking clear clinical standards, the standard of care often evolves through case law, expert testimony, and institutional practice patterns.

The Meta and Google verdicts may accelerate this process by:

  • Providing a judicially recognized framework for linking platform design to mental health harm;
  • Encouraging plaintiffs to incorporate digital exposure into causation narratives; and
  • Pressuring professional organizations to issue more explicit guidance in response.

In this sense, the verdicts may function as de facto catalysts for standard formation even if formal consensus lags behind.

Clinicians and treatment programs that proactively integrate digital-risk assessment may therefore position themselves more favorably relative to an emerging baseline of care.

Implications for Causation Frameworks in Eating Disorders

Historically, eating disorders have been understood through a multifactorial model, incorporating genetic predisposition, temperamental traits, family dynamics, trauma and sociocultural influences. The recent verdicts do not displace this model. However, they may recalibrate the weight assigned to environmental and systemic contributors, particularly those mediated through technology. Importantly, this shift may influence not only clinical practice, but also the narrative frameworks used in litigation and public discourse.

Anticipated Expansion of Social Justice and Structural Etiology Arguments

One of the more complex implications of these developments is the possible expansion of social justice based etiological frameworks, including arguments that locate eating disorders within broader systems of oppression.

Within certain academic and advocacy contexts, eating disorders have increasingly been linked to:

  • Eurocentric beauty standards,
  • Fatphobia,
  • Structural inequities in healthcare access, and
  • Cultural norms associated with what has been termed “White supremacy culture” (e.g., perfectionism, control, individualism).

The Meta and Google verdicts may indirectly reinforce these perspectives in several ways:

1. Externalization of Harm

By attributing liability to platform design rather than solely to individual behavior, the verdicts support a broader shift toward externalizing causation. This aligns with social justice frameworks that emphasize systemic over individual factors.

2. Validation of Environmental Influence

The recognition of algorithmic amplification as harmful lends credibility to arguments that cultural and media environments actively shape pathology, rather than merely reflecting it.

3. Expansion of Duty Beyond the Individual

If platforms can be held liable for contributing to mental health harm, analogous arguments may be advanced that cultural systems, institutional practices, and dominant norms also bear some responsibility for shaping risk.

As a result, Plaintiffs may increasingly incorporate cultural and systemic critiques, expert testimony on media ecology and sociocultural pressure, and arguments linking platform content to broader ideological frameworks as part of causation narratives.

Tension Between Clinical Rigor and Expanding Etiological Narratives

While these developments may broaden the scope of inquiry, they also introduce tension. From a clinical and evidentiary standpoint multifactorial models require specificity and measurable variables and overly diffuse causation theories risk diluting analytical precision.

From a legal standpoint courts require evidence that is not only plausible, but attributable and proximate. Expansive social frameworks (e.g., “White supremacy culture”) may be more difficult to operationalize in a manner that satisfies evidentiary standards. Accordingly, while social justice perspectives may gain rhetorical and academic traction, their translation into clinical standards or legal causation will likely depend on the development of measurable constructs, empirical validation, and clear linkage to individual harm.

Increased Eating Disorder Liability

For eating disorder related claims, liability may no longer depend on identifying specific harmful posts.  Instead, plaintiffs can target recommendation algorithms, engagement loops (likes, scroll, autoplay) and behavioral reinforcement systems. This aligns directly with how eating disorder pathology operates; repetition, reinforcement, and escalation, not isolated exposure.

Historically, eating disorder related litigation struggled with causation; eating disorders are multifactorial (genetics, trauma, culture) and Courts viewed platform influence as too attenuated.

The recent verdicts suggest juries are now willing to accept alternatives. The Los Angeles case framed harm through addiction mechanics; compulsive use, reinforcement loops and diminished control. This maps closely onto eating disorder pathology; compulsive restriction, bingeing, or purging, reinforcement through comparison and validation and escalating behavioral cycles.

Unlike traditional media, social media platforms learn user vulnerabilities and optimize content delivery accordingly. For eating disorder claims, this enables arguments that platforms did not merely expose users to harmful content. They systematically increased exposure based on detected susceptibility.

This is a qualitatively different form of causation, not passive distribution, but active behavioral shaping.

Among potential harm categories, EDs are uniquely positioned for litigation success due to a high predictability of harm. There is extensive internal and external research linking social comparison to body dissatisfaction to disordered eating. We now know that social media platforms can track repeated viewing of weight loss content, thinspiration and calorie restriction narratives. This creates a potential evidentiary record of foreseeable harm combined with continued amplification.

Courts are especially receptive to harms affecting minors and failure to implement protective measures. Eating disorder onset often occurs during adolescence, aligning directly with peak social media usage and peak psychological vulnerability.

Long-Term Structural Changes

As a result of these cases, we may see an emergence of “Digital Duty of Care” particularly for minors. Social media platforms may be held to standards similar to product safety law and pharmaceutical risk disclosure.  Courts may formalize liability tied to predictive amplification of harm. And we may see potential legislation impacting youth specific design standards, limits on engagement optimization and/or mandatory transparency for algorithmic systems.

We may also see evolving clinical implications for eating disorders. Eating disorders may increasingly be viewed not only as psychiatric conditions but environmentally induced or exacerbated disorders linked to platform design.

Clinicians should begin to document social media exposure patterns and incorporate platform use into diagnostic frameworks. This could strengthen litigation evidence and insurance coverage arguments.

In addition, eating disorders may be reframed as partially technology-mediated disorders. This parallels lung cancer (tobacco) and opioid addiction (pharmaceutical design and distribution).

The Meta and Google verdicts do not merely increase litigation risk, they signal a paradigm shift in how harm from digital systems is understood and adjudicated. For eating disorders, the implications are profound:

  • A viable legal theory now exists
  • Causation barriers are weakening
  • Platform design is becoming justiciable
  • Large-scale settlement frameworks are increasingly likely

Most importantly, these developments may redefine eating disorders not only as clinical phenomena, but as foreseeable outcomes of engineered environments optimized for engagement at the expense of psychological safety.

If this trajectory holds, the next phase of litigation will not ask whether platforms contributed to eating disorders, but to what extent, and at what cost.

THE DANGEROUS FICTION OF EATING DISORDER COACHES

The complexities of eating disorders require medical monitoring, psychiatric oversight, nutritional rehabilitation and clinical judgment. Eating disorders demand the highest level of expertise and professionalism from medical and mental health providers.

And yet, in a rapidly expanding corner of the wellness marketplace, they are being addressed by people who are not licensed, not regulated and, in many cases, not clinically trained at all.

They call themselves “Eating Disorder Coaches.”

There is no statutory definition of that role. No minimum education requirement. No mandated supervision. No governing board. No uniform ethical code enforced by law. It is merely a name. A brand. A vacuous title.

And no reliable mechanism to stop them if they cause harm.

Now make no mistake … there are “Eating Disorder Coaches” who are compassionate, intelligent professionals whose services are invaluable in working with a cohesive treatment team. But, in a community which rarely imposes consequences or adverse ramifications for reprehensible conduct, the danger of incompetent eating disorder coaches is far too real.

A Title Anyone Can Use

In most US states and in the UK, the title “eating disorder coach” is not protected. Anyone can adopt it. There is no state exam. No residency. No clinical hours requirement. No continuing education mandate enforced by a licensing authority.

A former state licensing board investigator describes the situation bluntly:

“From a regulatory standpoint, ‘coach’ is a marketing term. It does not confer legal authority, and it does not trigger professional oversight.”

If a licensed psychologist commits misconduct, a complaint can be filed. A board can investigate. A license can be surrendered, suspended or revoked.

If a coach commits misconduct, unless they also hold a license and the conduct falls squarely under licensed practice, there is often no comparable public accountability mechanism.

In practical terms, this means individuals with minimal training can advise medically fragile clients about food exposure, weight restoration, purging behaviors, exercise patterns and relapse decisions … issues that in clinical settings, are handled by multidisciplinary teams.

The danger is not theoretical.

A psychiatrist who specializes in eating disorders warns:

“Improper intervention can reinforce pathology. Poorly managed refeeding can have medical consequences. Missing suicide risk is catastrophic. These are not coaching issues. These are clinical issues.”

Yet the marketplace does not reflect that distinction.

The Coaching Loophole

The structural problem becomes especially stark when licensed professionals move into the unregulated coaching space.

Karin Lewis, an eating disorder clinician and founder of the Karin Lewis Eating Disorder Center in Boston, surrendered her Massachusetts therapy license while under investigation following two pending ethics complaints … including one filed by the therapist who began treating a former client after that client left Lewis’s care.

Separately, that client filed a civil lawsuit against Lewis for Lewis’ alleged unethical business practices. That case was resolved for an undisclosed payment.

However, Lewis’ licenses in New York and Rhode Island currently remain active… at least for the time being.

More recently, Lewis publicly presented herself on social media as an “Eating Disorder Coach.”

https://www.facebook.com/share/v/1DCba3vVBq/?mibextid=wwXIfr

The legal reality is striking: surrendering a license in one state does not prevent someone from operating as a coach. Coaching requires no license to surrender.  Instead, it is explained away as a personal and professional transition. In Lewis’ words, “I’m shifting to a coaching and consulting model.” Perhaps the rest of that sentence should have read, “Because I am prohibited from engaging in my chosen profession in my home state.”

Good Lord. From a profession where at least there is some oversight to a role that has no oversight, no requirements and no accountability. What could possibly go wrong?

Especially when you can belong to a community which will protect you no matter what so long as you hold the same idealistic, radical views espoused by others. Surrender your license? Not a problem. You can still serve on Advisory Boards of eating disorder treatment centers. No consequences. No accountability.

However, this is not a commentary on one individual alone. It exposes a systemic failure: professionals can exit regulated roles and continue working in adjacent, unregulated ones without a unified accountability framework.

This type of unregulated model is illustrated in a much larger context, that is, eating disorder board certification. [However, this article will not focus on certification. That is for a future date. It is only briefly included for context.]

Certification: The Illusion of Reform

Despite growing criticism, eating disorder certification programs have multiplied to an extent that would make rabbits blush. Like coaching, certification programs are unregulated, there is no oversight and anyone can create them. A person can include any private issue they like in a certification program … from Indigenous Person’s Land Use Acknowledgements to railing on White Supremacy Culture.

Project HEAL has expanded programming and provider networks while advocating for improved access to care. Inclusive Eating Disorder Education (IEDE) offers tiered credentials and training tracks. The Eating Disorder Institute (?) f/k/a The Institute of Contemporary Eating Disorder Education (ICEE) provides coursework and professional certificates. Iaedp’s certification program is undergoing broad changes because of litigation.

These initiatives often present themselves as raising standards in the field.

But certification is not regulation.

No state licensing board oversees these programs. No legislature defines their scope. No independent authority can revoke a certificate and legally bar someone from continuing to practice as a coach.

A healthcare policy scholar who studies professional licensure draws a clear line:

“A certificate means you completed a course. A license means the state has granted you legal authority to treat vulnerable people — and can remove that authority if you violate standards. They are fundamentally different.”

Certification programs may require coursework. They may encourage ethical guidelines. They may foster community norms.

But they do not create enforceable public protection.

And in some cases, critics argue, they risk compounding confusion.

“Consumers see badges, seals and credentials and assume oversight exists,” says a former hospital-based eating disorder program director. “But there is no disciplinary body behind most of these titles. It’s structural theater.”

These same issues exist with eating disorder coaching.

Coaching as De Facto Treatment

The most troubling development is not that coaching exists. Peer support has long played a role in recovery communities.

The problem arises when coaching becomes indistinguishable from treatment and therapy.

Coaches advertise meal plan guidance. Exposure support. Relapse prevention strategies. Accountability check-ins. Crisis navigation. Body image interventions.

These are not lifestyle adjustments. They are components of clinical care.

Eating disorders affect cardiac function, bone density, electrolyte balance and suicidality. Weight restoration can trigger refeeding syndrome. Purging behaviors can destabilize potassium levels to fatal effect.

In licensed treatment settings, these risks are monitored by medical professionals.

In coaching settings, oversight varies widely … and for the most part, does not exist at all.

A clinical ethicist frames the issue starkly:

“When someone markets themselves as capable of guiding recovery from a life-threatening illness, the absence of regulation is not an oversight. It is a policy failure.”

A Marketplace Built on Vulnerability

The expansion of coaching cannot be separated from systemic failures in access to care. Waiting lists are long. Insurance battles are common. Specialized treatment is expensive.

Desperate families look elsewhere.

The coaching industry has attempted to fill that void with polished websites, testimonials and social media authority. It operates largely outside insurance systems, outside hospital networks and outside state oversight.

In a traditional healthcare model, authority flows from licensure and statutory accountability.

In the coaching marketplace, authority flows from branding.

That shift should concern regulators.

As one former licensing official puts it:

“Regulation exists because vulnerable people cannot be expected to vet complex medical competencies on their own. When we remove regulation, we shift the burden of risk onto the patient.”

The Unanswered Question

Eating disorder coaching today exists in a regulatory grey zone that benefits providers more than patients.

Certification programs provide optics. Professional branding provides credibility. But neither substitute for enforceable oversight.

The core question remains unresolved:

Should individuals treating — or functionally treating — one of the most lethal psychiatric disorders operate without statutory accountability?

Until lawmakers address that question directly, through scope of practice laws, title protections or regulatory oversight, eating disorder coaching will remain what it is now:

A parallel system of quasi-clinical care, built on vulnerable populations, sustained by market demand, and largely immune from the guardrails that define the rest of healthcare.

And in medicine, immunity from oversight is rarely a virtue. It is a roadmap for catastrophic results.

Why we Acknowledge Awareness Week

It is Eating Disorders Awareness Week. A week in which organizations attempt to “raise awareness.” Presentations are made. The microscopically small niche on social media occupied by eating disorder advocates spout their messages using rote, familiar language while ignoring the most alarming statistic.

It is far easier to refine language than to examine outcomes. But outcomes are how we are judged. Outcomes determine our humanity. Our soul. Our fight for survival. And nowhere was this more apparent than in the incredible journey of Kaila Blackburn.

Everything I know about Kaila Blackburn I got from her strong, resilient, incredible mother, Debi and father, Tom. And what I read on social media.

Kaila was born on June 13, 1994, in Virginia, and on September 27, 2025, eating disorders took her life. Eating disorders took her from her family and her loving parents. But while she was with us, how she graced us with her strength.

Kaila was a natural student and athlete. She swam, dove, played softball, and ran with such breathtaking speed and grace that she earned the nickname “Flash.” Her dedication and talent carried her to Virginia Tech, where she proudly competed as a Division I runner.

From what I read, Kaila’s faith was the foundation of her life. From an early age, Kaila loved Jesus, and through her 31 years she remained steadfast, often teaching others through her wisdom and grace. Even in her hardest battles, she clung to her Savior with courage and unwavering trust.

Kaila’s parents wrote this about her, “We will not say that Kaila is “resting in peace.” Instead, we proclaim that she is Running in Paradise—whole, free, and forever embraced by the love of her Savior. That is exactly what Kaila would have wanted.”

I did not know Kaila. I never had the chance to meet her. But, I do take comfort knowing that my Morgan is probably showing her the ins and outs of the next plain of existence. And they are smiling, laughing and at peace.

This week, a Virginia television station did a story on Kaila. It can be found here:

https://www.wtvr.com/on-air/virginia-this-morning/observing-eating-disorder-awareness-week-kaila-blackburns-story

My heart goes out to Debi and Tom and her family. We belong to a horrific club that no parent should ever have to join.

Maybe this week, eating disorder awareness week, we should take just a moment, close our eyes, remember and honor those who have been taken. And in that moment of silence, perhaps we should reflect upon what our priorities should be going into the future.

As a parent who had a loving child taken by eating disorders, I hope and pray every day that Morgan’s life, that Kaila’s life, and the lives of many others, were not extinguished in vain. That perhaps the memory of them will inspire us all to do better. To set aside our petty differences. To pledge to strive forward together … with intelligence, wisdom, grace and collaboration.

So that in the future, there will be fewer Morgans and Kailas and Kellys and many others.

We parents remember. We mourn. We grieve. And yet, we continue to hope. And we continue to love.

And love should be the overriding message of awareness week.